Women may have pain with penetration or be unable to use a tampon. Pain can be on entry to the vagina, lower abdominal pain with sex, sharp pain during sex, pain with orgasm or pain after sexual intercourse.
Pain with intercourse can affect women of all ages but young women are most likely to have symptoms. Post menopausal women can have pain due to tissue changes, increased dryness and narrowing of the opening of the vagina.
Postnatal women can often experience pain with intercourse and those that deliver by c-section are three times more likely to experience this. Chronic pelvic pain and associated medical conditions can also cause painful intercourse. Pain with sex can understandably cause relationship problems and have negative emotional effects, so is best addressed sooner rather than later.
Dyspareunia is the word used for experiencing pain before, during or after vaginal intercourse. There are many causes of dyspareunia including insufficient lubrication, skin conditions, UTIs, pelvic organ prolapse, illness or surgery. Psychological causes such as issues with your relationship, history of sexual abuse, stress and anxiety can also contribute.
Vaginismus is a type of dyspareunia when tight/spasming pelvic floor muscles cause narrowing of the entry to the vagina. It is often the diagnosis given to pain at penetration and can make penetration impossible. Pain at penetration can also be caused by insufficient lubrication/arousal, inflammation or infection of the skin or nerve damage in the area (pudendal neuralgia).
Vulvodynia is the term given to pain experienced in the external sexual organs; the vulva, the labia, clitoris and vaginal opening.
Pain and the brain
Dyspareunia can often start with a physical cause (e.g thrush) but then persists because of changes in the brain. Your brain starts to associate pain with intercourse and a vicious cycle ensues. Your brain gets switched on to being on high alert and looking out for danger. If your brain is anticipating danger (painful sex) it may produce muscle spasm to try and protect you, however this makes sex more painful and further reinforces the pain cycle. Feelings of low self worth, anxiety and stress associated with painful sex and changes in a relationship, worsen the “alert” brain and therefore your sexual experience.
Physiotherapy for painful sex
Understanding what causes your symptoms is an important part of what your physio will do. Treatment options can include:
- Education about pain and the brain
- Pelvic floor relaxation techniques
- Dilator therapy
- Internal vaginal release techniques
- External manual therapy around the pelvis/hips
- Exercise therapy (including yoga)
- Referral to other health care professionals including psychologist, gynaecologist or sex therapist